Comparison of pregnancy outcomes between planned homebirth and planned hospital birth in WA, 2002-2013

Abstract

This project addresses Aim (2) and was designed to compare morbidity and mortality between planned homebirth and planned hospital birth in WA, 2002-2013, while accounting for patient characteristics, levels of risk at onset of labour and changes in policy and governance. Evidence suggests homebirth is a safe model of maternity care for women considered low risk at the onset of labour. To account for the increase in adverse outcomes associated with increased obstetric risk at the onset of labour, four levels of obstetric risk were created and assigned to each birth. Risk levels were defined according to the presence or absence of medical conditions (pre-existing or during pregnancy) or obstetric complications that could influence pregnancy outcomes. Confounding factors were established apriori and adjusted for in the analysis of all maternal and neonatal outcomes. Unadjusted and adjusted logistic regression modelling was performed on maternal and neonatal outcomes and compared between planned hospital and planned homebirths at each risk level. Low medical and obstetric risk hospital births were used as the reference level in all models.